Monitoring and Evaluation of
Breast Health Initiative
Dr Somesh Kumar
Sr Director, Technical Leadership and Innovations
Jhpiego
Breast Health
Initiative
Theory of Change
Performance Indicators
Input Indicators
Indicators Target
Proportion of targeted ASHAs/USHAs trained on breast
health awareness 80%
Proportion of targeted service providers trained on
clinical breast examination (CBE) 80%
Proportion of targeted MOs trained on clinical breast examination (CBE) & benign breast
conditions/treatment
80%
Proportion of targetted Specialists trained on Imaging,
Pathology & Procedures (Biopsy ) As per actual Proportion of data handlers trained on data recording,
reporting and compiling 80%
# of state technical advisory group meetings held As per actual
# of learning resource packages developed 3
# of trainers trained through ToTs As per actual
Process Indicators
Indicators Target
Median time taken by women from
nomination by CHW to CBE As per actual Median time taken by women from CBE till
reaching the diagnostic centre As per actual Median time taken by women from reaching
the diagnostic centre to diagnostic evaluation
As per actual Median time taken by women from
diagnostic evaluation to initiation of treatment
As per actual Median time taken by women from
initiation of treatment to completion of treatment
As per actual
Key Performance Indicators (KPI)
Output Indicators
Indicators Target
Percentage of operational targeted facilities
for early detection of breast cancer (CBE) 80%
Percentage of operational targeted facilities
for diagnostic evaluation of breast cancer 80%
Proportion of ASHA/USHA who have
conducted enumeration of target population 80%
Proportion of women who come to health
facility for CBE 20%
Average number of CBEs performed per
facility As per actual
Outcome Indicators
Indicators
Proportion of women referred for diagnostic evalution after CBE
Proportion of women who underwent diagnostic evaluation
Proportion of women who were confirmed to have breast cancer through diagnostic evaluation
Median size of breast lump of the women who are confirmed to have breast cancer
Proportion of women who need to receive treatment for breast cancer
Proportion of confirmed cases initiated treatment Proportion of confirmed cases completed treatment
Key Performance Indicators (contd)
Measurement Tools
Tools
• Recording: Enumeration Format, NPCDCS Screening register, CBE positive register, Diagnostic Register, Treatment Register
• Reporting : Monthly Reporting format
• Referral: Client referral slip, Client card
Processes
Data Quality Assurance
• Data quality was closely monitored for each data collection/activity tracking process. Data collection was planned in a way that quality is ensured and checked at various points of the data collection and compilation process.
• Data quality assurance steps:
✓ Development of standardised data tool with inputs from experts .
✓ Field testing of tool
✓ All data collectors will be oriented in a standardised manner.
✓ Data entry will be done in formats with data validation checks/restrictions
✓ 5-10% of data entered will be crosschecked for inconsistencies
✓ Triangulation of data with different sources
✓ Regular monitoring visits
Learnings: Regular sharing of dashboard improves program performance
Numbers
1 53
Rakesh.Singh@jhpiego.org
Numbers %
Enumeration 58027
CBE by Facility 7551 13% MPR
CBE +Ve by Facility 829 11% MPR
Went to Diagnostic of Facilities
women excluded VAB 269 32% 64 VAB
Drop Out 560 68%
Total reached to diagnostic 333 40%
CBE +Ve by Diagnostic 199 60%
USG Done 111 56% 88
Mammography 0 0%
FNAC/ FNAB done 6 5% 105
Biopsy done 5 5%
Referred to cancer treatment centre 6 5%
Drop Out Reasons no. of
reasons % Drop Out
Upcoming Week 224 42%
Unable to track 121 23%
Family issues 1 0%
Denied to go to hospital 5 1%
went Medical college/ Private hospital 33 6%
Others (new Cses) 152 28%
Total 536
Breast Health Dashboard of Uttar Pradesh
148 181 364
922
1615
129 108 273
654
1164 87%
60%
75% 71% 72%
0%
20%
40%
60%
80%
100%
0 500 1000 1500 2000
Doctor SN ANM ASHA Total
Training
Available Staff Trained Staff % Trained
25 20 10 15
5
0
% Cumulative +ve CBE findings
Total +ve CBE-829 Total women came to facility for CBE-7551
11%
Oct-18 to May-19
494, 31% 146, 9%
103, 7%
41, 3%
78, 5%
75, 5%
87, 5%
413, 26%
141, 9%
By Facility +ve CBE Finding Lump or thickening inside Swelling, warmth, redness Change in size, shape Dimpling or puckering of skin Itchy, scaly sore Pulling in of nipple Nipple discharge
New pain persistent in one spot No of CBE+ve women followed-up no.=829
58%
5% 3%
2%
0% 2%
3%
24%
3%
Diagnostic +ve CBE Finding no.=194
% Women came to facility
13
%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Total Enumeration
58027
285 359
738 837 916 1146
967
2303
31 47 62 103 146 166 88 186
10.9%
13.1%
8.4%
12.3%
15.9%
14.5%
9.1% 8.1%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
0 500 1000 1500 2000 2500
Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Month wise +Ve CBE Finding
No of women who came to facility for CBE No of women with +ve CBE findings % +Ve CBE
920
1399
350 462
682 598 764 826
300
832
418
110 121 59 53 71 63 44 58 159 66 25
12% 9% 17%
11% 10% 11% 6% 7%
53%
8% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
0 200 400 600 800 1000 1200 1400 1600
Facilities wise +Ve CBE Finding
No of women who came to facility for CBE No of women with +ve CBE findings % +Ve CBE No of women
who came to facility for CBE
No of women with +ve CBE findings and referred to diagnostic
centre
women reached to diagnostic
facility
No of women with +ve CBE findings at diagnostic
facility
No of women with +ve CBE findings have undergone
diagnostic evaluation
No of women with +ve CBE
having confirmed carcinoma breast
7551 829 333 199 111 8
13% 11% 40% 60% 56% 7%
India BHI (by end of 2020) –NOT TO BE SHARED, UNDER PUBLICATION
Women enumerated by
CHWs
Women came to facility for CBE.
Women with +ve CBE findings referred
to diagnostic facility.
Women reached diagnostic facility.
Women found to have +ve CBE findings at diagnostic
facility.
Women underwent diagnostic evaluation.
Women confirmed to have breast cancer.
42
%
68
% 65
% 42
4% % 6%
108,112 45,854 2,053 857 557 379 22 19
Women initiated treatment.
86
%
No. of CBE: 3247 No. of CBE +Ve: 524
